COVID’s 3rd Year: Experts Speak

2022 Year in Review Part 1

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Marianne O’Hare : Welcome to Conversations on Health Care. This week we take
a look back at the tumultuous year we have had , and the many
leading voices in health care who joined this show to navigate
year three of the pandemic. Now, here are your h osts, Mark
Masselli and Margaret Flinter.

Mark Masselli: Well, Margaret 2022, coming to a close and I think it's time to
take a look back at this remarkable roster of guests who joined
us throughout the year and what a challenging year it's been.
We began year three of the pandemic with the terrible surge
of Omicron .

Margaret Flinter: In spite of the widespread availability of COVID - 19 vaccines.
We marked the start of the year with a huge surge in cases
and hospitalizations and a spike in the death toll. Th at was not
the way we were hoping to turn the corner on the pandemic
as the year began.

Mark Masselli: We began the year with a guest who's become a fixture on this
show since the pandemic began. Dr. Peter Hotez,
internationally renowned physician and scie ntist, Dean of the
National School of Tropical Medicine at Baylor College of
Medicine, and most importantly, grew up in West Hartford,
not far from where we are today. But he shares our grave
concern about the growing anti - vax movement.

Dr. Peter Hotez : Ev entually, this will pass and then we've got to decide what
the world looks like post Omicron, we know, the old likely
Omicron is probably not going to produce much in the way of
durable protection, people will still need to get vaccinated. So
that's got to be a priority. To me, it's defeating this very
aggressive anti - vaccine activities that are causing people to
needlessly lose their lives by being defiant of vaccines. 200,000
Americans since June 1 , who refused vaccines lost their lives.
So , anti - vaccine / anti - science activities are top killer in the
United States. So we 've got to figure out how to conquer that.
And lastly, we've got to vaccinate the world to prevent the
new variants from emerging .

Margaret Flinter: Dr. Hotez has really become quite a trust ed voice in this whole
debate. And after years of research around SARS, his team
developed their own COVID vaccine with the goal of making it
available to the whole world in particular, to low resource
countries where the lack of vaccines was really devast ating.
That earned him a Nobel Prize nomination, which we were
really thrilled to see.

2022 Year in Review Part 1

Mark Masselli: Well. Another familiar guest joined us in January, Margaret,
Dr. Ezekiel Emanuel, former adviser to the Obama
administration, he issued a call for a new s trategy to confront
the Omicron surge, as it began to rage out of control.

Dr. Ezekiel Emanuel : We need a new – a whole new government arrangement, so
that automatically Health System , physician offices, labs ,
download data every day, and we get a public d isplay non -
identifiable data about where we're having outbreaks ? What
kind of viral illnesses are happening ? How many people are
dying ? We really need that data infrastructure. Israel can have
it , Britain can have it, we can too . In the modern age, you
kno w, Microsoft, and Google and Amazon and Facebook
having these data capacities, we really need to be able to do
that.

Margaret Flinter: And I think we can say Dr. Emanuel was one of many public
health officials that were expressing frustration with the
admi nistration over what really played as confusing messaging
about the pandemic. So , we're very happy to welcome CDC
director, Dr. Rochelle Walensky to the show, to really talk
about some of those concerns.

Dr. Rochelle Walensky : I think there's a little bit of misunderstanding , that following
the science implies that the science is always clear. It's always
black and white. Science is emerging. New science comes
every day, sometimes conflicting science emerges. And, you
know, I have this great privilege of wo rking with this incredible
scientific team, where it's a multidisciplinary group, we have
immunologist s and epidemiologists, and you know everything
in between. And we have robust dialogue about how we
interpret new and emerging science. And for the most p art,
we're unified and on the same page, and I think that that's
really terrific. But there is a lot of robust dialogue out there
that's playing out in the public view. Usually it's in scientific
meetings, but that is, you know, we should be having that
sc ientific dialogue.

Mark Masselli: Margaret you know, doing this show during the global
pandemic has given us a front row seat to the great minds who
have been toiling behind the scenes. Dr. Michael Osterholm,
from the University of Minnesota has advised ma ny
presidential administrations on pandemic preparedness and
he warned us in January not to become complacent about this
ever changing pathogen as COVID would continue to shape
shift .

Dr. Michael Osterholm : As you know, a year ago I was saying that I thoug ht the darkest
days of the pandemic could still be ahead of us based on the

2022 Year in Review Part 1

variance. Once I saw Alpha and Beta and Gamma . I said, Wow,
this virus has that potential to continue to throw 210 mile an
hour curveballs. Well, there's still that chance we're go ing to
have another one. That could be just like Omicron or worse,
where it evades immune protection. Were either from
vaccines or natural infection , and so we wanted to do was set
out an approach that says, well, we got to be ready for
something like that . But what if, in fact, that doesn't happen
again, and we start to see this become part of the seasonal
milieu of respiratory transmitted diseases .

You know, influenza on an average year kills 50 to 70,000
Americans in this country , and so our papers were really about
looking and reaching forward with the idea that we need to
learn to live with COVID.

Margaret Flinter: That's right , it certainly wasn't what we wanted to hear when
we were being so vigorous with the rollout of the vaccines that
began right th ere at the end of 2020. If you remember Mark
the week before New Year's 2020 when vaccines first arrived,
so let's not forget Mark , what the pandemic has done to our
country's children , to school children who were sent home in
March of 2020 as the pandemic took hold, U.S. Education
Secretary Miguel Cardona shared why it is so vitally important
that our kids be back in the classroom, while still protecting
their health and the he alth of their educators as well.

Miguel Cardona: What we've done, it happened wh en the Delta spike
happened maybe two weeks before school started . We really
were very strong at the Federal Department of Education,
communicating that it is the responsibility of our
superintendents and our Boards to protect our students and
our staff, a safe working environment, a safe learning
environment is critical. And we have worked closely with all
states to make sure that that message is there, we supported
our superintendents that are making decisions to protect
students and staff, everyone wants our kids in schools . We all
know the benefits of in - person learning, we have to leave
public health to the experts. But I also understand we all want
a day when masks are not required. But right now we know
especially with Omicron, we have to do everythin g in our
power to keep our children safe. And that's probably those
mitigation strategies that the CDC recommends.

Mark Masselli: Well, such an important pivot point in the pandemic,
Margaret, getting America's children back to schools, and
certainly Secre tary Miguel Cardona played such an important
role, as did another champion and close friend of ours,

2022 Year in Review Part 1

Congresswoman Rosa DeLauro, who joined us to discuss the
Child Tax Credit , which did so much to address child poverty
across the country.

Rosa DeLauro : One of the things that was so critically important to me was
the Child Tax Credit and the American Rescue Plan and look , it
is the Child Tax Credit that I believe was addressing the issues
of poverty. And you know, how poverty affects children, you
know, whet her it is their nutrition, their education, their
health, their future, what happens in their homes, so that the
Child Tax Credit , I believe, has met the need, and we got to
continue to fight for it to be extended. And we've seen already
that 50% of kids b eing lifted out of poverty in November , 2.8
million kids, that hunger numbers have declined , if I’m correct
I think it's the largest single reduction in child poverty that
we've seen in the United States. And that's been very
powerful. The pandemic laid ba re the deep inequities that
exist in this country, we know the impact they have. And also,
let us give a shout out to Dr. Cameron Webb, the White House
Advisor for COVID - 19 equity, he talked real truth to power
about the efforts targ eting inequity in Ameri ca today.

Dr. Cameron Webb : The vaccinations have been an absolute huge and game
changing intervention in communities of color. In changing
that trajectory of the differential mortality, what vaccines have
done is they've really reduced those, that rate of mortality.
And it's helped to level the playing field, if you will, because
while we can't change all those upstream factors that put
people at increased risk for severe outcomes . What we can do ,
is make sure that they have immunologic protection to
preve nt some of those worse outcomes . When you
complement that with some of the therapeutic options, what
we're able to do is really put together the pieces downstream
to prevent folks from dying disproportionately. But that does
not absolve us of the need to c ontinue to work upstream to
make it easier for communities that have historically been
hard hit to navigate this and future pandemic .

Mark Masselli: As the politics around pandemic reached a fever pitch. Dr.
Anthony Fauci joined us again, Margaret, I think five times
during the pandemic , we had him on many years earlier,
talking about his important work that he had done on the HIV
issue. But he was balancing his efforts as a White House Chief
Science Advisor against the politically motivated threats to his
own personal safety. And you know that this is just so unfair. I
think he realizes the political environment that he's in . He
admonished the political rhetoric, saying “now was not the
time to fight each other , when we're all battling a more

2022 Year in Review Part 1

dangerous foe . ”

Dr. Anthony Fauci : I think it's no secret Margaret , that we are now living in an
environment of profound divisiveness in our country. And
whenever you have something of the magnitude and impact of
a global pandemic that has severely involved our country, with
now approaching a million deaths , with a well over 930,000
deaths, we do see it and you can't walk away from it , a degree
of political divisiveness and even hostility that cannot help
when you're trying as a country in a unified way to respond to
an outbreak. The common enemy is the virus, we should look
at this metaphorically that we are at war with a common
enemy. And when you're at war with a common enemy, it's
not time or ever should be time of fighting with each other.
We should be focusing all o ur efforts on containing this
terribly devastating virus which has done such destruction
throughout the world, including in our own country.

Margaret Flinter: Well Mark, it has been truly shocking and so, so disappointing
to see the level of attacks agains t some of the most revered
members of the scientific community. And we do want to give
a shout out and best wishes as the year comes to an end to Dr.
Fauci on his retirement, May we all be as vigorously engaged
in our work at 80 as Dr. Fauci has been . So , big thanks to him
on behalf of the country. Meanwhile, some states really did do
a pretty great job of addressing the pandemic. Dr. Mary
Bassett was on the show, she has just been a rock star in the
public health world, she took over as the State of New Yo rk's
Health Commissioner , and she joins us to share their
successful strategies for containing the pandemic and really
ha d some powerful lessons to share.

Dr. Mary Bassett : We have a lot of data here. And we have been contributing to
the national conversat ion about vaccine protection. As you
know, we have a wonderful group of data scientists who've
been looking at the protectiveness of natural infection,
meaning getting COVID and vaccination, we released
information about the much more rapid rise of hospita lizations
among children in the pediatric population. Even though these
hospitalizations are rare. They were going up faster than the
hospitalizations for other groups.

So , we have a lot of data. We also have wastewater data. We
are collecting it now in fi ve counties scattered strategically
around the state, we have received funding to extend
wastewater surveillance to the entire state. So , we're looking
at our data. And I have not heard this about the CDC, we all
look to the CDC, for you know, for data and for guidance. But

2022 Year in Review Part 1

of course, it is true that during this pandemic states have
occasionally had to make decisions that were out ahead of the
CDC, New York State has done that, as have other states. And
that's because we look at our data and tried to decide what's
best for the people who live in our state.

Mark Masselli: You know, as this global pandemic engulfed all of us , the world
also watched in horror as Russia launched a war against
neighboring Ukraine. We welcome several brave clinicians
from inside U kraine delivering care as Russian shells were
pounding their cities . We first welcome family clinician, Dr.
Kateryna Pochtar to the show, Margaret I think you
remember, she would go back to her clinic and then hear the
sirens and then go into the bomb shel ters and just repeat that
all , every day -- What incredible heroes of health care workers
in Ukraine are .

Dr. Kateryna Pochtar : The houses are destroyed, hospitals are destroyed,
kindergartens are destroyed. Compared with the S outhern and
E astern part of Uk raine, Rivne is a safe place at the moment.
Our Medical Center is safe . T here is a bomb shelter in the
ground floor. My colleagues and me keep doing our best to
take care of our patients. Everyone is on his / her workpl ace.
When we share an air alarm, we go downstairs to the bomb
shelter. patients and medical staff are staying in the bomb
shelter as long as it is needed. Then we come back to our
offices and continue and again and again. We work hide, work,
hide. My patients are scared. They are crying in my o ffice. As
for me, I'm not scared. But I' m worried about my family. I'm
thinking about them all the time. My parents and my brother
and his wife a nd little son are in small town, Enerhodar . There
is a nuclear power plant there. The Russians are just on the
entrance of this city . People are hiding , it's unbelievable — the
nuclear power plant, it is so dangerous to attack this town , but
anyway . My kids are with their grandmother in the village , also
hiding. I can’t see them. I can’t talk to them, they need my l o ve
and support so much , but I'm so far.

Margaret Flinter: I don't know that I've ever heard more powerful stories from
health care workers and that feeling of duty and obligation to
serve and continue to provide care. And a few weeks later, a
very similar story from another family clinician inside Ukraine ,
Iryna Voloshina , who talked about what it's like to deliver care
under siege and just the stress that it takes. Having your
children cared for by other members of the family, not
knowing what might happen . We remember the horrific
incident of the maternity patients being moved to a safer
location that was then bombed. I don't think any of us can

2022 Year in Review Part 1

fully appreciate the incredible stress that these individuals , so
brave , so committed were under .

Dr. Iryna Volo shina : Our moral state. I characterize like, quite strong. But I worry
very much about my patients and about our doctors who are
staying now in totally blocked and occupied territories. It is
completely awful situation , there is humanitarian catastrophe,
b ecause people completely lost , even food.

Mark Masselli: You're right on, Margaret, such bravery , every day family
clinicians dealing with the health needs of this devastated
country under really frightening conditions.

Margaret Flinter: There's really no shortage of heroes, Mark, I think, as we've
known over the years, and as we've often had the opportunity
and the honor of having these guests on Conversations on
Health Care, their story provides a backdrop to somebody who
we have known and who we had admi red for many years. And
that was Dr. Paul Farmer, the late Dr. Paul Farmer, the founder
of Partners in Health. He's been a guiding light for what we do
and I think, shared our common ethic of if you want to see
change in the world, you better go out and st art building it.
But he built a global standard for creating a robust community
health system in some of the poorest places in the world. And
not just building the delivery system, but also the training and
the education of the community health workers and the
nurses and the physicians, he will always be remembered. He
passed away unexpectedly in the spring of 2022, his longtime
Medical Director, Dr. Joia Mukherjee joined us to talk about
Paul's enduring legacy

Dr. Joia Mukherjee : In accepting that inequali ty, that economic, social and racial
inequality, you will never achieve health as a human right , and
so what Paul challenges all of us to do, even in death is to treat
every person as if you would your own family . You wouldn't
say well, we have $3 , this is all we can do. In fact, I've seen
impoverished people walk miles expend huge amount of
resources, sell their own assets, home , animals, just to get
care for a child. So the $3 is never enough. And we should
never think that we can provide health care as a human right
without massively looking at these unequal structures. And
Paul called that structural violence, and indeed, it is violent.
And I think that is really his greatest contribution.

Margaret Flinter: Well, Mark, as we know, policy doesn't stop for pandemics or
wars. But policy does amplify the need to put resources w here
they will do the most good. CMS Administrator Chiquita
Brooks - LaSure , joined us to talk about the Biden
administration's proposed health budget, which had a big

2022 Year in Review Part 1

focus on improving our public health infrastructure and
addressing the unprecedented mental health and addiction
crises underway in the country today.

Chiquita Brooks - LaSure : We are so excited about this President's budget. As we all
know, starting with mental health, the CO VID 19 pandemic has
just put such a strain on the mental health of Americans across
the country. And all of us with children certainly know how
much our nation's children have really suffered during this
time period. And certainly, children who are in unde rserved
communities are really at a crisis level. That's just the tip of the
iceberg , and so as you hopefully are seeing, we have a
department wide focus on mental health, really looking across
all of the agencies to really see what we can do. And I would
say about CMS in particular. Our focus has been , and is going
to be on the programs we serve.

Mark Masselli: Meanwhile, politics were getting in the way of approval of
more funding to fight the pandemic. Dr. Georges Benjamin of
the American Public Health A ssociation, decried the situation
and how short sighted it was.

Dr. Georges Benjamin: People know where their money is. But public health has been
so under value d and under supported , under finance d for
many years, that the money that did go out , bill ed on e time
capacity and that longtime capacity . And this new $10 billion
agreement is going to help a little bit more. But in many ways,
it's really a drop in the bucket of what’s needed to give every
community the capacity and supports that we need, anytime a
new health threat enters a community.

Margaret Flinter: And as we know Mark, the pandemic amplified this crisis of
unmet mental health needs . I t existed before , but it really was
amplified. During the pandemic and well known advocate and
TV journalist Jan e Pauley joined us to share her own
experience why she's dedicat ing her efforts to growing a
community health center movement in her home state of
Indiana, where mental health care is fully embedded in the
primary care setting.

Jane Pauley: It has been a v ery important advocacy role. And I think one of
the reasons that I was invited to share my name was because
the first the Jane Pauley of community health clinics would
have the behavioral health component, and that perhaps
knowing my story would invite peo ple to take advantage of
those services. I've since learned that most people who take
advantage of the services that Mark and his team offer don't
know who Jane Pauley is or was. They're just glad that the
clinics are there for their use when they need the m.

2022 Year in Review Part 1

Mark Masselli: Several other guests addressed our mental health crisis this
past year, Dr. Tom Coderre of SAM H SA, the Department of
Substance Abuse an d Mental Health Services at HHS.

Dr. Tom Coderre : Let's just talk a little bit about harm reduction, be cause really,
that approach is really all about saving lives. Harm reduction is
proactive, and it's evidence based. It's to reduce the negative
personal and public health impacts of any behaviors that are
associated with alcohol and other substance use. An d it's, as
you pointed out a very important part of the Biden - Harris
administration's comprehensive approach to addressing the
crisis that we're in the middle of . Through the bringing
prevention, treatment and recovery services to individuals
where they ar e to help them work through their own goals, to
help bring them across the Stages of Change.

Margaret Flinter: Also, Dr. Thomas Insel, former longtime Director of the
National Institute for M ental H ealth, joined us to talk about his
new book on the subject Healing: Our Path From Mental
Illness to Mental Health .

Dr. Thomas Insel : It's outrageous that families take their adolescent to an
emergency room, and they're told that they have to wait nine
days or 12 days for a bed , and so their 17 - year - old is chained
to a gurney day and night for 12 days in the back of an
emergency room. And that is happening every day across
America. That is not acceptable , and so it's time for families to
begin to say to people who represent them, “ we're not going
to put up with thi s ” . You know, I say in the book that we're
sort of in the Jim Crow era of mental health care. I mean, this
is just outrageously unjust. It's unethical. It's a painful
immorality in this country. And yet, there's no reckoning until
people are faced with it themselves. And then they're so
overwhelmed by the crisis that they're in that they can't tell
they can manage that, let alone become advocates for a social
change.

Mark Masselli: Former Trump , White House COVID advisor Dr. Deborah Birx,
shared her inside story from her personal experience
attempting to guide the previous administration, du ring the
height of the pandemic.

Dr. Deborah Birx : This is bigger than who's in the Oval Office, certainly who's in
the Oval Office can really impact communications and
c ommunications is critical. So , I don't want to make light of
that I talk about in the book a lot. The mishandling of
communications by the Trump - White House calls significant
issues on the ground and caused amazing confusion among
the American people , and so that has to be fixed and there has

2022 Year in Review Part 1

to be consistency there. But we also have to have a safety net
that says every American ought to be able to see the data
themselves.

Margaret Flinter: That was fascinating, reflecting back on all the many times that
we saw her on the news. We also welcomed an author and
science writer at The Atlantic , Ed Yong, who won this year's
Pulitzer Prize for the remarkable coverage that he provided
around the pandemic .

Ed Yong : Both the administration have gone very hard on this very
individualistic stance on the pandemic, this idea that we're
going to -- As I've said already , use biomedical
countermeasures, pharmaceutical interventions to get our
way out of this without having to put in the work of building
up the social support. And the other kinds of measures, things
like masking , ventilations, testing, all the rest that would
protect the health of the population at large. Both have failed
in their own specific ways to really shore up public health at a
time we really need it. A nd I think that, you know, again,
Trump was deeply problematic and wrong in his approach to
the pandemic. But I think if the only lesson we learned from
these two plus years is -- it was all on Trump. I think we've
absolutely learned the wrong lesson . The problem was in the
rootstock. The problems are foundational and longstanding
and fundamental.

Mark Masselli: Well, in my rethinking of suffering another tragic mass
shooting at another elementary school this time in Uvalde,
Texas, Florida teacher Sarah Ler ner joined us to talk about her
experience surviving the mass shooting in Parkland, Florida.
She is part of a national organization of teachers seeking
legislation to address America's gun violence epidemic.

Sarah Lerner: We are working to make communities and schools safer,
because we know it's not just school shootings or gun violence
in school, it's gun violence in communities of color. It's suicide
by gun violence, its domestic violence, and it all finds its way
into school, because it's the baggage and the trauma that
these kids carry with them, or that you as the educator carry
with you.

Margaret Flinter: And of course, in this month of December, the Sandy Hook
massacre in Connecticut, the Sandy Hook School shootings,
has just marked its 10th anniversa ry. And I think people in
Connecticut will probably never fully recover from that any
more than they will in the other S tates. So , much work to do.
Our children just deserve better from us, as do their teachers
and administrators.

2022 Year in Review Part 1

Mark Masselli: Yeah, they certainly do. We did enjoy a bright spot. This year,
we celebrated the 50th anniversary of the start of our own
organization, Community Health Center, Inc orporated . We've
watched it grow from a Free Walk - In Clinic run by activist and
volunteers back in 19 72 , to you know, world class national
organization, helping to transform the way primary care is
delivered .

Margaret Flinter: Hopefully it hasn't lost a bit of that youthful spirit , but nice
opportunity to see how far we've come and the dramatic
changes th at have occurred in American health care over the
years.

Mark Masselli: And how far we still have to go , Margaret . Next week we'll
continue our look back at this year's many memorable guest
we've welcomed here at Conversations on Health Care
including a bi llionaire entrepreneur attempting to disrupt
America's costly prescription drug market, epidemiologists
who helped eradicate smallpox and a farewell visit from Dr.
Anthony Fauci .

Margaret Flinter: What a year ! And you can learn more about Conversations on
Health Care by going to www.chcradio.com . We want to thank
you for being part of this experience. Joining us and welcoming some of the great thinkers in health policy , in
public health and pandemics , and the transfor mation of care.
We appreciate you very much . Happy holidays to everybody.

Mark Masselli: Happy holidays , and peace and health. I'm Mark Masselli .

Margaret Flinter: And I'm Margaret Flinter .

Mark Masselli: Pe a ce and health .

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Marianne O’Hare : Conversa tions on Health Care is recorded in the Knowledge
and Technology Center Studios in Middleton, Connecticut, and
is brought to you by the Community Health Center. Now
celebrating 50 years of providing qualit y care to the
underserved, where health care is a r ight, not a privilege,
www.chc1.com and www.chcradio.com .

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